Ask a Radiation Oncology Resident Anything...

[thesauce]

Gracias.

De nada. But I may be coming back to you for lifting advice.

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[loveoforganic2]

I'm primarily interested in heme/onc and am planning on doing research in that area in a coming MPH gap year between 2nd and 3rd year. I would like to rotate through radonc to see if I enjoy it, but if I do end up falling in love with it, am I going to have boned myself by not having done radiation-specific research?

Also, this poster I don't think ever had his question answered, and it seemed like a very good one (I've only shadowed a tiny amount in radonc, and I had a bit of negative experience due in part to the physician himself, but the things this poster brought up also come to mind)

I have a question here from a medical student. I came into medical school wanting to do RadOnc because I worked for a device manufacturer in Palo alto selling linacs and planning software after college. When I finally got to school and started working with residents and attendings at our cancer center, I became very discouraged about RadOnc because it seemed like it was more "tech-y" than "medicine-y". Most of the patient management was performed by someone in medicine, clinic visits were mostly performed by nurses, treatment was delivered by therapists, and most of the technical planning was done by physicists. After spending a year and a half in front of a computer screen watching people draw contours on a CT sim, I started looking for something else to do. My question is: what in particular excites you about Radiotherapy in practice? Please do not take this a snarky or condescending question because I truly am interested in RadOnc. Before I decide that RadOnc is not for me, I would like to know if maybe my experience is specific to my institution only? Thanks in advance...

 

[nabilesmail]

I have this weird growth on my thumb and figured out how to keep my microwave on with the door open, should I stick my thumb in the microwave to try and rid myself of the growth? It would be really cool to play doctor early!

 

[thesauce]

I'm primarily interested in heme/onc and am planning on doing research in that area in a coming MPH gap year between 2nd and 3rd year. I would like to rotate through radonc to see if I enjoy it, but if I do end up falling in love with it, am I going to have boned myself by not having done radiation-specific research?

Also, this poster I don't think ever had his question answered, and it seemed like a very good one (I've only shadowed a tiny amount in radonc, and I had a bit of negative experience due in part to the physician himself, but the things this poster brought up also come to mind)

Research never hurts, but if you do decide to do radonc, it's worth putting in the time and effort to get some radonc-specific projects going.

See post #56

 

[loveoforganic2]

Research never hurts, but if you do decide to do radonc, it's worth putting in the time and effort to get some radonc-specific projects going.

See post #56

Thanks, and thanks, skimmed by that one apparently!

 

[thesauce]

I have this weird growth on my thumb and figured out how to keep my microwave on with the door open, should I stick my thumb in the microwave to try and rid myself of the growth? It would be really cool to play doctor early!

That would be fine. Just make sure that you 4D-CT sim and plan for daily kV-kV match for image-guidance. Your physicists will undoubtedly perform the proper Q.A. before you start.

 

[nabilesmail]

That would be fine. Just make sure that you 4D-CT sim and plan for daily kV-kV match for image-guidance. Your physicists will undoubtedly perform the proper Q.A. before you start.

That was too confusing! I no longer want to be a doctor :/

Haha thanks for playing along

 

[The Buff OP]

De nada. But I may be coming back to you for lifting advice.

First, consult with your physician.

Whatever happen to the lazers dude?

 

[xroc]

First, consult with your physician.

 

[Ansar]

There are a lot of different kinds of research going on. Bench and clinical including radiation biology and radiation physics related. I do mostly clinical research, but have done bench research in the past.

Most radoncs work in private practice. Some in hospitals and some in free standing centers (I would guess half and half). I always have numerous projects going on as do all of my attendings (because I'm at an academic program). We've had numerous undergrads work on projects with us.



You could probably find an opportunity to do radonc research at this stage if you really sought it out. I don't think it would be a waste of your time. It's never too early to check out the field.

Thanks for the reply! Like you said, there's a lot of different research, but what type of work did the undergrads do? I guess compared to a bio major, I have other skillsets (mainly messing with programming languages and the physics background as opposed to knowing how to do a western blot or pcr) so I don't know how useful they would find me.

Again, thanks for the reply! Very informative
Oh, and what's a free-standing center? Sounds like a private practice to me...?

 

[tiedyeddog]

Just showing up on time with an eager "can do" attitude is enough. Be sure and try some treatment planning.

Thanks! I am looking forward to this rotation, should be great hours and interesting diseases!

 

[MVP]

Research never hurts, but if you do decide to do radonc, it's worth putting in the time and effort to get some radonc-specific projects going.

See post #56

what kind of research do medical students do? 2-3 publications for a graduate student would take at least 2 years of dedicated time. how can medical students push out that much research within the course of their 4 years to be competitive for a residency?

 

[thesauce]

Thanks for the reply! Like you said, there's a lot of different research, but what type of work did the undergrads do? I guess compared to a bio major, I have other skillsets (mainly messing with programming languages and the physics background as opposed to knowing how to do a western blot or pcr) so I don't know how useful they would find me.

Again, thanks for the reply! Very informative
Oh, and what's a free-standing center? Sounds like a private practice to me...?

I've seen undergrads do bench research and coordinate clinical trials. One did a dosimetry project (contouring and coming up with a consensus CTV - basically looking at a bunch of treatment plans and seeing what's the same and what's different and what could be acceptable middle ground).

Freestanding centers are outpatient clinics where patients come daily for their radiation treatment. They can be either private practice or part of a larger academic/hospital network.

 

[thesauce]

what kind of research do medical students do? 2-3 publications for a graduate student would take at least 2 years of dedicated time. how can medical students push out that much research within the course of their 4 years to be competitive for a residency?

These are mostly clinical reviews. Get a copy of the red journal and you will see some of what med students are publishing. No one expects 2-3 publications from bench research, although there will definitely be applicants that have that.

 

[chillaxbro]

I'm going to shadow a radiation oncologist
What should I expect?

 

[thesauce]

I'm going to shadow a radiation oncologist
What should I expect?

Good info in this FAQ: http://forums.studentdoctor.net/showthread.php?t=674353

 

[chillaxbro]

What questions should I ask him to impress him and make me look smart?

 

[thesauce]

What questions should I ask him to impress him and make me look smart?

It really depends on the service you're on. Do you know yet?

 

[chillaxbro]

It really depends on the service you're on. Do you know yet?

Not even sure what that means

 

[thesauce]

Not even sure what that means

Each physician generally has an area of expertise that makes up a majority of what they see. If they see mostly CNS and you are working with them, you are on the CNS service. Other typical services include: thoracic, peds, H&N, GI, breast, etc.

 

[chillaxbro]

each physician generally has an area of expertise that makes up a majority of what they see. If they see mostly cns and you are working with them, you are on the cns service. Other typical services include: Thoracic, peds, h&n, gi, breast, etc.[/quote

Not sure what he mainly does but he lists these services on his profile

3 dimensional conformal therapy
adult brain tumors
brachytherapy
brain cancer
brain cancer (brain tumor)
brain tumor
breast
breast cancer
cancer of lung (lung cancer)
cancer of the breast (breast cancer)
cancer of the cervix (cervical cancer)
cancer of the endometrium (uterine cancer)
colon cancer
glioblastoma multiforme
head and neck neoplasms
head/neck cancer
image guided radiotherapy
intensity modulated radiotherapy
lung cancer
lymphoma
oncology
pancreatic cancer
radiation oncology
radiation therapy
radiosurgery
radiotherapy (radiation therapy)
rectal cancer
skin cancer
vaginal cancer
vulvar cancer
zevalin

 

[thesauce]

each physician generally has an area of expertise that makes up a majority of what they see. If they see mostly cns and you are working with them, you are on the cns service. Other typical services include: Thoracic, peds, h&n, gi, breast, etc.[/quote

Not sure what he mainly does but he lists these services on his profile

3 dimensional conformal therapy
adult brain tumors
brachytherapy
brain cancer
brain cancer (brain tumor)
brain tumor
breast
breast cancer
cancer of lung (lung cancer)
cancer of the breast (breast cancer)
cancer of the cervix (cervical cancer)
cancer of the endometrium (uterine cancer)
colon cancer
glioblastoma multiforme
head and neck neoplasms
head/neck cancer
image guided radiotherapy
intensity modulated radiotherapy
lung cancer
lymphoma
oncology
pancreatic cancer
radiation oncology
radiation therapy
radiosurgery
radiotherapy (radiation therapy)
rectal cancer
skin cancer
vaginal cancer
vulvar cancer
zevalin

Sounds like he does a bit of everything. Ask him, for the cases you see with him, what dose he used/plans to use and why. It's hard to come up with any more specific questions without knowing the specific case.

Tell him that you saw on his profile that he uses Zevalin and ask how often and for what cases (google it so you know what it means). As him if he works with any other physicians when he gives it.

 

[sliceofbread136]

Would pediatric oncology research still be helpful for matching in radiation oncology if I changed interests?

 

[thesauce]

Would pediatric oncology research still be helpful for matching in radiation oncology if I changed interests?

Yes, but radonc specific research is always the most beneficial

 

[dirigo]

I'm not quite sure if you'd know the answer to this but here you go...

How well can doctors gauge the stage of cancer by looking at the ct scan?

 

[DrDreams]

Have you ever had to deal with a situation in where a child was diagnosed with a terminal cancer, and there were never really options for this kid. Then have the parents ever gotten upset with you?

Aside from the depressing thing, I worry about this as much as well.

 

[thesauce]

I'm not quite sure if you'd know the answer to this but here you go...

How well can doctors gauge the stage of cancer by looking at the ct scan?

It depends on the cancer. Generally you need a more extensive workup than just a CT such as bloodwork and other imaging. Sometimes you don't need a CT at all.

 

[thesauce]

Have you ever had to deal with a situation in where a child was diagnosed with a terminal cancer, and there were never really options for this kid. Then have the parents ever gotten upset with you?

Aside from the depressing thing, I worry about this as much as well.

I'm sure this scenario comes up all the time, but from our standpoint as a consult service, we usually just give an answer of whether radiation is indicated or not. The primary team (i.e. pediatric oncologist) is generally the one that has to break the bad news and quarterback the treatment plan.

 

[dirigo]

It depends on the cancer. Generally you need a more extensive workup than just a CT such as bloodwork and other imaging. Sometimes you don't need a CT at all.

thanks for replying-- i'm specificaly asking about stomach cancer actually. What's the best way to gauge gastric cancer's stage?

I'm sure you speak to cancer surgeons all the time. How often are they doing surgery to remove a tumor but then go in surprised to see the it's not one mass but spread all over? Which leads to another question...

Would some radiologists be more talented/experienced at reading the mets of the cancer to prevent this "suprise" during surgery?

 

[thesauce]

thanks for replying-- i'm specificaly asking about stomach cancer actually. What's the best way to gauge gastric cancer's stage?

I'm sure you speak to cancer surgeons all the time. How often are they doing surgery to remove a tumor but then go in surprised to see the it's not one mass but spread all over? Which leads to another question...

Would some radiologists be more talented/experienced at reading the mets of the cancer to prevent this "suprise" during surgery?

H&P, UGI with biopsies, CT C/A/P, PET/CT, CBC/CMP, EUS (most beneficial for T-stage).

It is common for a surgeon to go in with the intention of a gross total resection and find that they can't get it all. That's usually an indication for adjuvant chemo and/or radiation.

Yes, potentially a "better" radiologist or new radiological technique/technology could help prevent some of these cases.

 

[DrDreams]

I'm sure this scenario comes up all the time, but from our standpoint as a consult service, we usually just give an answer of whether radiation is indicated or not. The primary team (i.e. pediatric oncologist) is generally the one that has to break the bad news and quarterback the treatment plan.

Thanks for answering.

 

[tiedyeddog]

Finishing up my rad onc rotation tomorrow.

It's been awesome. I don't see myself going into the field but I can understand why people love it. I had no idea what dosimetry was before the rotation. I would recommend the rotation to anyone, it is a radically different field than any other I have experienced.

 

[thesauce]

Finishing up my rad onc rotation tomorrow.

It's been awesome. I don't see myself going into the field but I can understand why people love it. I had no idea what dosimetry was before the rotation. I would recommend the rotation to anyone, it is a radically different field than any other I have experienced.

Thanks for reporting back. It is definitely not for everyone, but I love it and can't imagine doing anything else.

 

[FenderTuni]

Hi lazers! Thanks for doing this, it's a HUGE help for everyone.

In mi case, I'm an IMG with a strong conviction towards Rad Onc since my first MS years. If everything goes well I'll be taking the USLME Steps in 2015 (at the latest). So that means tons of time for preparation in order to achieve at least a 250-260, in fact I already began studying Kaplan lectures notes, FA and so on.... However some US Radiation Oncologist attendants have given me the advice of doing IM prior to Rad Onc application....does it really worth it ???? I mean, of course it would enhance mi application, but as a future rad oncologist (HOPEFULLY) it would be THAT useful in my clinical practice?? or it's just a tip for getting into the competition.

What are your thoughts about it? Any personal recommendation ?

Thanks in advance!

PS: some background "in a nutshell" of my situation: No research (for now), opportunity of doing an observership / shadowing with some DemiGod's in the field; hence possible LOR's, 1 year of "Family Medicine like" clinical experience in rural sectors, plenty of oncologist in my family and a lot of faith.....

 

[t3705]

Have you ever treated somebody with a pxa brain tumor and if so, how did it go?

 

[zeppelinpage4]

Thanks so much for all the great info.! I had one concern and could use some advice...I know I could change my mind, but assuming I had an interest in radiation-oncology right now.

I looked at my med schools website (Stony Brook) and found out it doesn't have a radiation oncology residency....in fact it doesn't have any oncology related residency program whatsoever. I'm really bummed because I picked this school expecting it to have more residency opportunities and it seems to be the opposite case.

But Stony Brook does have a cancer center, with a radiation oncology department and a medical physics training program for PhD students...so there are related things going on there. But it lacks a residency training programs in radiation-oncology.

It is also a big research institution, so I feel like there should be some type of radiation-oncology research going on, but for some reason the school doesn't have any residencies in this field. If I tried shadowing some radiation-oncologists at the cancer center and did some related research (at Stony Brook or another institution) for next summer, would the lack of a radiation-oncology residency department be significantly detrimental?

Thanks again!

 

[Turquoise7]

I really appreciate the fact that you take the time to respond so openly to us... I've learned so much already!

Okay, so in a previous post I read that the cutting edge technology is what really seemed interesting to most people who pursue radiation oncology. That's not me so much, so that makes me a bit nervous. I'm more interested in the one-on-one relationships that I would be able to build with patients and the ability to see the treatment plans that I've created make a difference in people lives. I'm a non-traditional student currently in the field of education (with a background also in psychology) but completing my prereqs to attend medical school. It's very important that I find a specialty area where I can actually see that I'm having a positive impact on people and enhancing the quality of life of my patients. With all of that being said can you please address the following questions (if possible, using a 1 (not often/poor) to 10 scale (very often/incredible) (sorry I'm so particular) and please feel free to elaborate on your ratings )...

What parts about your day seem a bit boring or monotonous and what's the worst part of your job (clearly can't use the scale)? How often on a weekly basis is your day boring or monotonous? How often do you feel on a weekly basis rewarded for the work that you do? In general, how much do patients appreciate the work that you do? On a typical day, how emotionally draining is the work that you do? On a typical day, how mentally stimulating is the work that you do? In general, to what extent do your interactions with patients make you a better person? In general, to what extent do your interactions with patients make you a better doctor? How respected do you feel by professionals and physicians that you have to work with in other disciplines (e.g., oncologists, dosimetrists, physicists)? Are you a parent or spouse (I am both ), if so, to what extent does your job allow you to fully participate in the lives of those that you love? Based upon your own perception, how much independence do you have to make decisions as a resident when compared to same year residents in other specialty areas? This may be more specific to your actual program but as a resident, how helpful/positive/invested are the attendings that you work with? Overall, how satisfied are you in the field of radiation oncology as a resident? Overall, how satisfied do you anticipate that you'll be in this field as an attending?

Thanks in advance for your grace... because I know that I have asked a ton of questions!! You really have no idea how exciting, informative, and helpful this thread has been. Running across this thread today has hands down been my highlight of the week!!!

 

[The Buff OP]

TheSauce has been holding it down. Lazers hasn't reply for a while.

Sauce, take it away, broham.

 

[yehhhboiii]

.

 

[thesauce]

Hi lazers! Thanks for doing this, it's a HUGE help for everyone.

Ummm.....

... However some US Radiation Oncologist attendants have given me the advice of doing IM prior to Rad Onc application....does it really worth it ????

No. I don't understand this advice.

I mean, of course it would enhance mi application,

I don't know that it would. Not many believe in the "more is better" philosophy and radiation oncology is so far removed from other specialties that I don't see much benefit even in terms of medical knowledge. As I understand it, you can only have so many years of funding for GME and if your IM residency eats into it, I don't know that you could even find a program to take you. However, I don't know the specifics on this, so don't quote me.

What are your thoughts about it? Any personal recommendation?

Radonc is very competitive even for AMG. I don't know if there has been an IMG who has matched in recent years. You have a very uphill battle ahead of you. I recommend that you have a backup specialty in mind. Best of luck!

 

[thesauce]

Have you ever treated somebody with a pxa brain tumor and if so, how did it go?

No. I saw a patient with a PXA in consult, but we did not recommend radiation.

 

[thesauce]

Thanks so much for all the great info.! I had one concern and could use some advice...I know I could change my mind, but assuming I had an interest in radiation-oncology right now.

I looked at my med schools website (Stony Brook) and found out it doesn't have a radiation oncology residency....in fact it doesn't have any oncology related residency program whatsoever. I'm really bummed because I picked this school expecting it to have more residency opportunities and it seems to be the opposite case.

But Stony Brook does have a cancer center, with a radiation oncology department and a medical physics training program for PhD students...so there are related things going on there. But it lacks a residency training programs in radiation-oncology.

It is also a big research institution, so I feel like there should be some type of radiation-oncology research going on, but for some reason the school doesn't have any residencies in this field. If I tried shadowing some radiation-oncologists at the cancer center and did some related research (at Stony Brook or another institution) for next summer, would the lack of a radiation-oncology residency department be significantly detrimental?

Thanks again!

Not having a home program is frustrating, but not insurmountable. Stony Brook had someone match at Duke (a solid mid-tier program) this year and Memorial Sloan Kettering (arguably the #1 program) 2 years ago.

You will need to rotate at a department with a program early in your 4th year to get a solid LOR. You will have good research opportunities at Stony Brook.

Good luck!

 

[thesauce]

With all of that being said can you please address the following questions (if possible, using a 1 (not often/poor) to 10 scale (very often/incredible) (sorry I'm so particular) and please feel free to elaborate on your ratings )...

This is a first, but okay

What parts about your day seem a bit boring or monotonous and what's the worst part of your job (clearly can't use the scale)?

Running to the machine and checking port films is monotonous, but important.

The worst part is seeing a patient in followup and having to tell them that their disease has progressed. It doesn't happen very often (they have usually been told by someone else before they come to see us), but it can and does happen, and it sucks.

How often on a weekly basis is your day boring or monotonous?

3

How often do you feel on a weekly basis rewarded for the work that you do?

8

In general, how much do patients appreciate the work that you do?

9

On a typical day, how emotionally draining is the work that you do?

2

On a typical day, how mentally stimulating is the work that you do?

7

In general, to what extent do your interactions with patients make you a better person?

I don't know that I understand the question. You are who you are. I don't know that I've really changed a lot aside from learning how to interact better with my patients and colleagues.

In general, to what extent do your interactions with patients make you a better doctor?

8. As above.

How respected do you feel by professionals and physicians that you have to work with in other disciplines (e.g., oncologists, dosimetrists, physicists)?

Very big variation in this regard. Some love us and some hate us.

Are you a parent or spouse (I am both ), if so, to what extent does your job allow you to fully participate in the lives of those that you love?

Spouse. We have lots of time together.

Based upon your own perception, how much independence do you have to make decisions as a resident when compared to same year residents in other specialty areas?

More than most specialties because most of what we do can be "undone." We are given free reign to come up with a treatment plan and write the radiation script. If the attending doesn't like it, they can change the plan and/or the script. Even after the treatment has been started, it can usually be modified. So we can usually go to town from day 1. There also isn't much of a hierarchy. Junior and senior residents all do the same job because we just rotate through different services (often as the sole resident on that service). There are progressive expectations as you move up, but not necessarily progressive responsibilities.

This may be more specific to your actual program but as a resident, how helpful/positive/invested are the attendings that you work with?

10

Overall, how satisfied are you in the field of radiation oncology as a resident?

10

Overall, how satisfied do you anticipate that you'll be in this field as an attending?

10

Thanks in advance for your grace... because I know that I have asked a ton of questions!! You really have no idea how exciting, informative, and helpful this thread has been. Running across this thread today has hands down been my highlight of the week!!!

Thank you

 

[t3705]

Thesauce, thanks.

 

[zeppelinpage4]

Not having a home program is frustrating, but not insurmountable. Stony Brook had someone match at Duke (a solid mid-tier program) this year and Memorial Sloan Kettering (arguably the #1 program) 2 years ago.

You will need to rotate at a department with a program early in your 4th year to get a solid LOR. You will have good research opportunities at Stony Brook.

Good luck!

Thanks thesauce! It definitely is frustrating, but I feel a lot better having read your post and seeing that Stony Brook grads have done it in the past.

Just a quick follow up question. If I rotated at a radiation-oncology department somewhere else, could that give me similar exposure and advantages to students who had a radiation-oncology department in their own med school? Assuming all else was equal of course.

I'm just trying to see to what extent rotating somewhere else could make up for a lack of a radiation-oncology department at my own school.

Much appreciated-Zp4 p.s. Bouncing off of Turquoise7's, this thread really has been an awesome read. I would not have known any of this, or this field without your answers.

 

[thesauce]

Just a quick follow up question. If I rotated at a radiation-oncology department somewhere else, could that give me similar exposure and advantages to students who had a radiation-oncology department in their own med school? Assuming all else was equal of course.

Whether it does or not, it's really the only thing you can do. Even with a home program, you have to put in the time and effort of making connections and getting involved in research. Some people with a home program never really do that and end up without much added benefit. If you have good scores, research, and LORs, you stand a good chance of matching.

Much appreciated-Zp4 p.s. Bouncing off of Turquoise7's, this thread really has been an awesome read. I would not have known any of this, or this field without your answers.

Happy to help.

 

[sunflower18]

This was touched on, in that most residents have no knowledge of advanced physics before medical school, but is radiation-relevant physics anything like introductory physics? Can someone hate introductory physics but enjoy radiation oncology? Does anyone go into radonc mostly for the interest in oncology rather than for the interest in technology and math and physics?

 

[zeppelinpage4]

Whether it does or not, it's really the only thing you can do. Even with a home program, you have to put in the time and effort of making connections and getting involved in research. Some people with a home program never really do that and end up without much added benefit. If you have good scores, research, and LORs, you stand a good chance of matching.



Happy to help.

Thanks thesauce, looks like I'll just try to do the best I can with what I have. But I do feel much better after getting your advice. Although frustrating, it's good to know my doors are not shut if I work hard and put the effort in...which is necessary anyways even if I did have a program at Stony Brook.

Thanks again! I'm really glad I got to learn all of this before starting my first year.

 

[Turquoise7]

This is a first, but okay



Running to the machine and checking port films is monotonous, but important.

The worst part is seeing a patient in followup and having to tell them that their disease has progressed. It doesn't happen very often (they have usually been told by someone else before they come to see us), but it can and does happen, and it sucks.


Thanks so much thesauce... really appreciate your feedback!

 

[katizzle]

How much did the lifestyle factor into your choice to go into this field?